Prostate cancer mortality and metastasis under different biopsy frequencies in North American active surveillance cohorts

Abstract

BACKGROUND: Active surveillance (AS) is an accepted means of managing low-risk prostate cancer. Because of the rarity of downstream events, data from existing AS cohorts cannot yet address how differences in surveillance intensity affect metastasis and mortality. This study projected the comparative benefits of different AS schedules in men diagnosed with prostate cancer who had Gleason score (GS) ≤6 disease and risk profiles similar to those in North American AS cohorts. METHODS: Times of GS upgrading were simulated based on AS data from the University of Toronto, Johns Hopkins University, the University of California at San Francisco, and the Canary Pass Active Surveillance Cohort. Times to metastasis and prostate cancer death, informed by models from the Scandinavian Prostate Cancer Group 4 trial, were projected under biopsy surveillance schedules ranging from watchful waiting to annual biopsies. Outcomes included the risk of metastasis, the risk of death, remaining life-years (LYs), and quality-adjusted LYs. RESULTS: Compared with watchful waiting, AS biopsies reduced the risk of prostate cancer metastasis and prostate cancer death at 20 years by 1.4% to 3.3% and 1.0% to 2.4%, respectively; and 5-year biopsies reduced the risk of metastasis and prostate cancer death by 1.0% to 2.4% and 0.6% to 1.6%, respectively. There was little difference between annual and 5-year biopsy schedules in terms of LYs (range of differences, 0.04-0.16 LYs) and qualityadjusted LYs (range of differences, −0.02 to 0.09 quality-adjusted LYs). CONCLUSIONS: Among men diagnosed with GS ≤6 prostate cancer, obtaining a biopsy every 3 or 4 years appears to be an acceptable alternative to more frequent biopsies. Reducing surveillance intensity for those who have a low risk of progression reduces the number of biopsies while preserving the benefit of more frequent schedules. Cancer 2020;126:583-592.

Does Protocol Make a Difference? Comparison of Two Prostate Cancer Active Surveillance Cohorts: A Non–protocol-based Follow-up and a Protocol-based Contemporary Follow-up

“…In addition, data from the pre-PSA era suggest that men not followed according to a strict protocol still have excellent PC survival [13] , [14] . Interestingly, our results are also well in agreement with a recent study in which a simulation model was developed to study the impact of biopsy frequencies on mortality and development of metastasis in men on AS [15] . The authors concluded that a less frequent biopsy schedule might be the preferable option.…”

ADAM10-cleaved ephrin-A5 contributes to prostate cancer metastasis

“…Though some prostate cancer metastasis-related markers, such as serum miR-141 and exosomesderived miR-141-3p has been found [31,32], it is far from clinical application. Our finding that ephrin-A5 is disassociated from EphA3 and released outside the cell by ADAM10 suggests that ephrin-A5 may have certain diagnostic value in prostate cancer metastasis [33]. The similar ephrin-A5 content in serum of the patients with prostate cancer and BPH indicates that serum ephrin-A5 cannot be used as a marker of common prostate malignancy.…”

Upgrading on Per Protocol versus For Cause surveillance prostate biopsies: An opportunity to decreasing the burden of active surveillance

“…Given the prolonged natural history of prostate cancer, patients omitting PPSBx are unlikely to experience worse oncologic outcomes from the delay in upgrading by waiting for a change in clinical status, which would then have prompted a FCSBx. 25 Our study has several notable limitations. First, this a retrospective registry study of patients undergoing surveillance biopsies.…”